How did you sleep in the ICU? Critical Care 2011, 15:408
Franck L., et al.
http://ccforum.com/content/15/2/408
Sleep is important for healing and survival of critical illness, as far as quantitative and qualitative sleep deprivation can have negative consequences on a physiologic function, particularly the immune mechanism, as well as psychological well-being. We explored the memorization of sleep disturbances during an ICU stay and then evaluated the quality of sleep reported by patients after critical care.
Wednesday, 15 June 2011
Is cytomegalovirus reactivation increasing the mortality of patients with severe sepsis?
Is cytomegalovirus reactivation increasing the mortality of patients with severe sepsis? Critical Care 2011 15:138
Kalil AC and Florescu DF.
Critically ill patients who are immunocompetent before intensive care unit (ICU) admission may also become more prone to develop active CMV infection if they have prolonged hospitalizations, high disease severity, and severe sepsis. The development of active CMV disease has been associated with a significant higher risk of death in several previous studies. This Critical Care edition brings a new study by Heininger et al in which they found that patients with severe sepsis who developed active CMV infection had a significantly longer ICU and hospital stays, prolonged mechanical ventilation, but no changes in mortality compared to patients without CMV infection.
Kalil AC and Florescu DF.
Critically ill patients who are immunocompetent before intensive care unit (ICU) admission may also become more prone to develop active CMV infection if they have prolonged hospitalizations, high disease severity, and severe sepsis. The development of active CMV disease has been associated with a significant higher risk of death in several previous studies. This Critical Care edition brings a new study by Heininger et al in which they found that patients with severe sepsis who developed active CMV infection had a significantly longer ICU and hospital stays, prolonged mechanical ventilation, but no changes in mortality compared to patients without CMV infection.
Prolonged mechanical ventilation in critically ill patients
Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit.
Lone NI and Walsh TS.
http://ccforum.com/content/15/2/R102
The number of patients requiring prolonged mechanical ventilation (PMV) is likely to increase. Transferring patients to specialised weaning units may improve outcomes and reduce costs. The aim of this study was to establish the incidence and outcomes of PMV in a UK administrative health care region without a dedicated weaning unit, and model the potential impact of establishing a dedicated weaning unit.
Lone NI and Walsh TS.
http://ccforum.com/content/15/2/R102
The number of patients requiring prolonged mechanical ventilation (PMV) is likely to increase. Transferring patients to specialised weaning units may improve outcomes and reduce costs. The aim of this study was to establish the incidence and outcomes of PMV in a UK administrative health care region without a dedicated weaning unit, and model the potential impact of establishing a dedicated weaning unit.
An evidence-based recommendation on bed head elevation for mechanically ventilated patients
An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Critical Care 2011, 15:R111
Niël-Weise BS, et al.
A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. Methods: A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure. Results: Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45 degrees bed head elevation was effective or harmful with regard to the occurrence of clinically suspected ventilator-associated pneumonia (VAP), microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45 degrees elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45 degrees position and preferably in a [greater than or equal to] 30 degrees position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes
Niël-Weise BS, et al.
A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. Methods: A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure. Results: Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45 degrees bed head elevation was effective or harmful with regard to the occurrence of clinically suspected ventilator-associated pneumonia (VAP), microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45 degrees elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45 degrees position and preferably in a [greater than or equal to] 30 degrees position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes
Sedation and renal impairment in critically ill patients
Sedation and renal impairment in critically ill patients: a post-hoc analysis of a randomized trial. Critical Care 2011, 15:R119
Strom T, Johansen RR, Prahl JR and Toft P.
http://ccforum.com/content/15/3/R119
Not sedating critically ill patients reduces the time patients receive mechanical ventilation, decreases the time in the intensive care department and reduces the total hospital length of stay. We hypothesized that no sedation improves hemodynamic stability, decreases the need for vasoactive drugs, diminishes the need for extra fluids and lowers the risk of acute kidney injury.
Strom T, Johansen RR, Prahl JR and Toft P.
http://ccforum.com/content/15/3/R119
Not sedating critically ill patients reduces the time patients receive mechanical ventilation, decreases the time in the intensive care department and reduces the total hospital length of stay. We hypothesized that no sedation improves hemodynamic stability, decreases the need for vasoactive drugs, diminishes the need for extra fluids and lowers the risk of acute kidney injury.
Care bundles: implementing evidence or common sense?
Care bundles: implementing evidence or common sense? Critical Care 2011 15:159
Camporota, L and Brett S.
Care bundles aim to improve standard of care and patient outcome by promoting the consistent implementation of a group of effective interventions. However, a variety of barriers prevent their full application in clinical practice. Here, we discuss some of the benefits and limitations of care bundles in the delivery of safer and more effective and consistent health care.
Camporota, L and Brett S.
Care bundles aim to improve standard of care and patient outcome by promoting the consistent implementation of a group of effective interventions. However, a variety of barriers prevent their full application in clinical practice. Here, we discuss some of the benefits and limitations of care bundles in the delivery of safer and more effective and consistent health care.
Are we sedating more than just the brain?
Are we sedating more than just the brain? Critical Care 2011 15:163
Brummel NE and Girard TD.
Heavy sedation in the ICU is associated with coma, delirium, and prolonged stays, but links between sedatives and non-brain organ failure have rarely been described. In a post-hoc analysis, Strom et al. explored associations between sedation and acute kidney injury among ICU patients randomized to one of two sedation strategies. The "no sedation" protocol was associated with less kidney injury, but methodologic limitations preclude firm conclusions regarding mechanisms underlying this association. This hypothesis-generating study warns that sedation may harm organs other than the brain during critical illness, a possibility that warrants careful study in the future.
Brummel NE and Girard TD.
Heavy sedation in the ICU is associated with coma, delirium, and prolonged stays, but links between sedatives and non-brain organ failure have rarely been described. In a post-hoc analysis, Strom et al. explored associations between sedation and acute kidney injury among ICU patients randomized to one of two sedation strategies. The "no sedation" protocol was associated with less kidney injury, but methodologic limitations preclude firm conclusions regarding mechanisms underlying this association. This hypothesis-generating study warns that sedation may harm organs other than the brain during critical illness, a possibility that warrants careful study in the future.
Fever in septic ICU patients: friend or foe?
Fever in septic ICU patients: friend or foe? Critical Care 2011 15:222
Launey Y, Nesseler, N, Malledant Y and Seguin P.
In recent years, fever control in critically ill patients by medications and/or external cooling has gained widespread use, notably in patients suffering from neurological injuries. Nevertheless, such a strategy in septic patients is not supported by relevant data. Indeed, in response to sepsis, experimental and clinical studies argue that fever plays a key role in increasing the clearance of microorganisms, the immune response and the heat shock response. Moreover, fever is a cornerstone diagnostic sign in clinical practice, which aids in early and appropriate therapy, and allows physicians to follow the infection course. After discussing the physiological aspects of fever production, this review aims to delineate the advantages and drawbacks of fever in septic patients.
Launey Y, Nesseler, N, Malledant Y and Seguin P.
In recent years, fever control in critically ill patients by medications and/or external cooling has gained widespread use, notably in patients suffering from neurological injuries. Nevertheless, such a strategy in septic patients is not supported by relevant data. Indeed, in response to sepsis, experimental and clinical studies argue that fever plays a key role in increasing the clearance of microorganisms, the immune response and the heat shock response. Moreover, fever is a cornerstone diagnostic sign in clinical practice, which aids in early and appropriate therapy, and allows physicians to follow the infection course. After discussing the physiological aspects of fever production, this review aims to delineate the advantages and drawbacks of fever in septic patients.
Totem and taboo: fluids in sepsis
Totem and taboo: fluids in sepsis. Critical Care 2011 15:164
Hilton, AK and Bellomo, R.
The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the fluid paradigm. The salient aspects of the trial need to be understood and reflected upon. In this commentary, we discuss the background to and findings of the trial and explain why they will likely trigger a re-evaluation of our thinking about fluids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care.
Hilton, AK and Bellomo, R.
The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the fluid paradigm. The salient aspects of the trial need to be understood and reflected upon. In this commentary, we discuss the background to and findings of the trial and explain why they will likely trigger a re-evaluation of our thinking about fluids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care.
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